Hinged Joint Revision after 4 years of problems

[Craig1]

@sistersinhim thank you very much for your kind comments. I too am absolutely thrilled with my rom at this stage. After having mua’s in the past I suspected this would be the case this time around but things are looking good for further improvement.

 

[Josephine]

I wanted to know was would my movement left and right be curtailed eg., crossing my legs?

Oh! Gotcha! Well, the whole point of the constrained knee is to give the patient as much rotation as with the standard device and almost as much rotation as the natural knee. So things like crossing the legs should be entirely attainable. But then I've never been able to cross my legs anyway so! Some people just can't.

 

[shelli22]

Hi @Craig1. I’ve just read through you thread and I was was amazed you ended up having a revision. Did they consider an arthroscopy for arthrofibrosis prior to the decision to do a revision or was there very little scar tissue there when they did the MUA. What prompted the revision?


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[Craig1]

@shelli22 thank you for reading my thread. My revision tkr was down to instability, nothing to do with scar tissue though I believe there was plenty of it when the revision was done! So far my recovery from my revision is going well though still have not achieved a rom much over 70 degrees. I have an appointment with my surgeon today so will see what he says about this.
@Josephine thanks for your reply. For someone who used to have hypermobility its strange for me not being able to sit with my leg under me or crossed. Hopefully it will come with time, fingers crossed!

 

[Craig1]

Appointment with my surgeon on Monday went well. ROM at 80 degrees however I have a lag of 25 degrees which is unexpectedly throwing me forward when I am least expecting it! Surgeon thinks this is down to weak muscles @Josephine do you have any thought on this? Apart from this at six weeks my wound has healed well with minimal swelling.

 

[Josephine]

I have a lag of 25 degrees which is unexpectedly throwing me forward

Sorry, I have no idea what this means.

 

[Craig1]

@Josephine let me try to explain! I cannot do a straight leg raise, my knee has a bend of about 25 to 30 degrees when lifted. On a few occasions this week it has been like someone is kicking me in the back of the knee and my knee is quite violently pushing forward and looks as if it is dislocating. I hope this helps?

 

[AnnieC]

Wow! That’s excellent ROM! I’m at the same stage as you and nowhere near on the left knee. Right knee is ok. I think you can give yourself a Noddy Badge!


Bilateral Total Knee Replacement 27 November 2017

 

[Josephine]

I just realised my mistake - I'm accustomed to the dates having most recent at the top. I've been thinking you had your surgery September 2013!!!

So I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[Craig1]

@Josephine I certainly will answer your questions. Wishing you and all the fellow bonesmarties a Happy Christmas and health and happiness for 2018.

 

[Josephine]

Here y'go then!

It would be very helpful if you would answer each one individually - numbered as I have done - in as much detail as you can then I'll come back as see where you are ....

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. how swollen is your leg compared to these?

4. what is your ROM - that's flexion (bend) and extension (straightness)

5. are you icing your knee at all? If so, how often and for how long?

6. are you elevating your leg. If so how often and for how long?

7. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

8. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each
etc., etc.

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each
etc., etc.

 

[Craig1]

@Josephine here we go

1. Pain level no more than a two though when I try to walk putting my foot on the ground it goes up to about a six. Still need crutches.

2. Prescribed medication Dihydrocodeine 30mg Paracetamol as required. At this stage taking no more than 4 paracetamol a day

3. No swelling at all though when knee is giving it does swell slightly.

4. Flexion 80 degrees extension 0 degrees. Still no straight leg raise leg lifting with 25-30 degree lag.

5. Still elevating and icing for about an hour maybe three times a day.

6. Answer as question 5

7. Doing cooking minimal housework compared to my usual, ironing shopping

8. Not really doing much physio at all
Static quads x10 reps x5 3 times a day
Heel slides x10 reps x5 3 times a day
Nothing else just general walking still with crutches indoors and outside,

 

[Josephine]

1. Pain level no more than a 2 though when I try to walk putting my foot on the ground it goes up to about a 6

Okay

2. Prescribed medication Dihydrocodeine 30mg Paracetamol as required. At this stage taking no more than 4 paracetamol a day

I've never know dihydrocodeine to be that affecting for knees. I think you'd be much better off with Tramadol. Can you contact your GP, tell him the dihydro isn't working for you and please can you have something else like Tramadol? You would also take this with paracetamol. Tramadol 50-100mg every 6hrs and an accompanying couple of paracetamol!

3. No swelling at all though when knee is giving it does swell slightly.

That's good.

4. Flexion 80 degrees extension 0 degrees

Not so good.

5. Still elevating and icing for about an hour maybe three times a day.

You accomplish little or nothing with that, Make it at least 4 times a day.

6. Answer as question 5

Same again.

7. Doing cooking minimal housework compared to my usual, ironing shopping

I don't quite understand this - you mean you ARE doing ironing and shopping or you are not?

Not really doing much physio at all - I wouldn't say that! You doing 300 reps of these a day!
3 sessions a day - make it one session a day and none at all at the weekends
Static quads x10 reps x5 - not a good one to do and 150 reps a day is bad. I suggest you stop it.
Heel slides x10 reps x5 - same again- far too much
Nothing else just general walking still with crutches indoors and outside - that's okay provided you stick with the routine in here Activity progression for TKRs

I've found a lot of members say "I'm not doing much" and then tell me about a routine that is way too much. That plus the inadequate pain med is what is causing your pain as described in Q1. I would strongly recommend that you stop all the exercises and just let your leg heal and progress in its own time. That's what I did and many others on here. I recommend you read my recovery thread to see how little exercising I did for either knee! Knee recoveries UK style Parts I & II (Josephine)

 

[Craig1]

@Josephine I’ve had quite a few episodes of my knee giving way from back to front. Could I have damaged my patella tendon? What are the symptoms if this has happened?

 

[Josephine]

The patellar tendon doesn't have anything to do with this. What's more likely is that your thigh muscles need to be strengthened. But walking should do, nothing too intense.

 

[Craig1]

@Josephine Saw my surgeon last Monday 11 weeks post op. ROM at 80 degrees though he wasn’t concerned with it. Wound looking good though still a lot of instability when walking. I’ve not to go back for six months. My question Josephine is if my rom doesn’t improve by then what will happen?

 

[Craig1]

Hello I haven’t been on the forum regarding my knee for a long time. I am now over two years since my revision and I have been having a lot of pain in the distal area below my knee and at the top of my tibia. This pain is worse than the arthritic pain I had before my tkr. I have seen my surgeon who says the implant is positioned fine. The last few days I have had huge amount of clunking from the implant. Any advice would be welcome. The implant is a rotating hinge one.

 

[Celle]

@Craig1 - I'm sorry you've had to come back with pain again.
Did your surgeon suggest any reason for the pain?

 

[Craig1]

@Celle thank you for your reply. All my surgeon said was that the implant seems fine. He did bloods and said that he’d write to me with the results.

 

[Jaycey]

@Craig1 have you thought about getting a second opinion? Sounds like you need a fresh set of eyes looking at this. If you tell me where you are in the UK and what surgeon you have already seen I might be able to help you locate someone new.